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Home My Public Portal About10765 GRAND AVE_Mechanical__ P F§ 7ZAJ6'4 - CEBIB -.3-69 APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES 7'L DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W.JENKINS,SUPERINTENDENT OF BUILDINGC p FOR APPLICANT TO FILL IN OWNER O ✓� C (PRINT OR TYPE ONLY) MAIL f NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS S E ABSORPTION SYSTEM, BTU CITY TEL. NO.y l O AIR HANDLING UNIT, CFM CONTRACTOR wo BOILER, .HORSEPOWER ADDRESS CITY TEL. NO. COMPRESSOR, HORSEPOWER STATE LIC. LICENSE N0. CLASS VENTILATION SYSTEM DISTRICT NO. GROUP ZONE/ P OCESSED BY EVAPORATIVE COOLER 7r Ir I FURNACE: FAU GRAVITY FLOOR BTU INSPECTION RECORD HEA ER: SUSPENDFp UNIT W A L ? CL V oc O G W CL NEW-ADDITION PERMIT $ 3 00 Z ALTER_REPAIR_ TOTAL FEE $ PLAN CHECK APPLICANT NAME ADDRESS CITY TEL. N0. I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING HEATING,VENTI- LATING, AIR CONDITIONING, APPROVALS D 1 P CTOR'S IGNATURE 171L tt—kr–, I HEREBY CERTIFY THAT 1 AM NOT ACTING IN VIOLATION OF ROUGH CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL I CODE OF THE STATELA ORN ' SIGNATURE ,JACK R. ALLAN, 5, ERVISING MECHANICAL E OF PERMITTEE PERMIT VALID,A-T1 CK. M.O. Cl�7H PLAN CHECK VALIDATION ,04-SIo 5 5 2 7 A 18 4 1 8.00- SEE EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE _ • WORKERS' COMPENSATION DEOAizA11ON APPLICATION FOR PERMIT �Irysure, or$fflrm that I hove a certificate of cont to self certificate of Workers' ComperrsationnInsu a ce, or a cernfled copy thereof (Sec 3800, Lab. C) „�+c HEATING - VENTILATING - AIR CONDITIONING 27-0646 DPW 9/88 F�ollcy No Company j /&P)L*4j:r Certlfied ropy Is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY rtlfl copy I ed with a cos ty bull g Inspec- FOR APPLICANT TO FILL IN a�,00� 0 � ' t d me (PRINT OR TYPE ONLY) /0 e y ca NO. TYPE OF APPIJANCE_OR EQUIPMENT FEE LOCALITY `'_' T CERTIFICATE OF D(EMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST. (Thls'secHon need not be compktod If the work Involved by ABSORPTION UNIT, BTU o+STRtCT No. P By the permlit is for one hundred'dollars (;100) or Iess.) .0 I certify that In the performance of the work for which this AIR HANDLING UNIT, CFM permit Is Issued, I shall not employ any person In any manner so as to become subject to the Wo eri Compen}atlon BTU I�h �� Date Ilcan ` COMPRESSOR, BTU � �. w RWM f�3 NOTICE TO eAPPLI�: f, after making this Ifitate of VBMLATION SYSTEM FINAL j Exemption, you should'become subject to the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATNE COOLER VALI AT ' N with compI with such provisions or this permit shall be deem- ed revoked. ) FURNACE- FAU GRAVITY / UCENSED CONTRACTORS DECLARATION 1 FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPETIDED UNIT- (commencing with Section 7000)of Division 3 of the Business WALL i#n` Ions and my license iVfu rce and effect.7 .3 3O , o u oc oA V YJ O am exempt under,Sec. Plan check fee G B.BP.0 for this reason a PERMIT ISSUING FEE $ Date: Z TOTAL FEE Signature OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractors License Law for the following reason (Section 7031.5, Business and SME Professions Code): t ❑ 1, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work endTEL NO. -.__.ACCTA the structure Is not Intended or offered for sale(Section CITY ? 7044, Business and Professions Coda �� ❑ OWNER -. -- I, aerty s owner of the prop , am contracting conactfng with licensed contractors to construct the project (Sec- MAIL �� (310tlon 7044, Business and Professions Code} ADD CONSTRUCTION LENDING AG8JC1' Sys / M TEL ff�p � 1 I hereby affirm that there is a construction lending agency for fSC. O QECK 55. the performance of the work for which this permit Is Issued CONTRACTOR CAW 00 (Sec. 3097, C Iv. C • ADDRESS Lender's Name L�.RJZRJtJi .7/121,090111 V Lenders Address STATE' UC 1• PM12:07 I certify that I have read this application and state that the UCENSE'NO. CLASS above Informatlon Is correct. I agree to comply wlth,all County ordinances and State laws relating to bulld]N construction, and hereby authorize representatives of this County to enter upoptthe above-mentioned property for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date �+